"Sequential treatment in prostate cancer is really something that’s evolving over time," Dr. Daniel Petrylak said of the study findings presented at the European Society of Medical Oncology Congress 2019.

BY Dr. Daniel Petrylak

PUBLISHED October 07, 2019

Third-line treatment with Jevtana (cabazitaxel) improved survival among patients with metastatic castration-resistant prostate cancer, according to findings from the CARD trial.

At the European Society of Medical Oncology (ESMO) Congress 2019, CURE spoke with Dr. Daniel Petrylak, professor of medicine and urology at Yale Cancer Center, about these findings and what they mean for the metastatic castration-resistant prostate cancer treatment landscape.

Transcription

Sequential treatment in prostate cancer is really something that’s evolving over time. We don’t really have an algorithm to help us determine what’s the right drug to use in a given situation.

So, the CARD trial looked at those patients who received docetaxel and at least one second-generation anti-androgen as prior treatment, and they were randomized to receive cabazitaxel or a second-generation anti-androgen such as [Xtandi (enzalutamide)].

And what was found from the study was that there was a better progression-free survival in those patients who received cabazitaxel versus those patients who received the next-generation agent, suggesting that there still is some resistance to the hormonal agents, whether that be through AR-V7 or other mechanisms.

One of the thoughts had been that perhaps, if you treated a patient with chemotherapy such as docetaxel, and they’ve received [Zytiga (abiraterone)] or enzalutamide, that those patients may be re-sensitized in that situation, because of the fact that you can knock out the clones that are AR-V7-positive with docetaxel.

This is actually going against that particular hypothesis and it’s showing that chemotherapy after next-generation androgen docetaxel is the way to go.